1.

In your experience what did you think of your time in medical school and
residency? What type of continuing education do you have to complete?
My medical school was a bit different than the classical path. I had completed
dental school prior to starting medical school. I completed dental school at the
University of Iowa. As I completed my clinical rotations I fell in love with oral
and maxillofacial surgery so similar to medical school I applied to oral and
maxillofacial surgery residencies. I applied to both the University of Iowa,
University of North Carolina and LSU Health Science Center in New Orleans. I
subsequently ranked LSU #1 as it was an opportunity to see it all, do it all and
essentially move away from the Midwest although I truly love the Midwest and
Iowa. Ultimately I matched in New Orleans and spent medical school and
residency at the Louisiana Health Science Center in New Orleans. Medical
school for me was essentially abbreviated as my first year residency we were
covering oral and maxillofacial surgery clinic as well as call responsibilities at
night addressing facial trauma and infections. During the day we would go over
and do medical school such as introduction to clinical medicine, clinical
pathology and so forth. After the initial year we moved into the clinical
rotations of 3rd and 4th year. Medical school was fantastic for me has during
rotations for example in OB/GYN I realized that I was not going to go down this
path for a career so I enjoyed the opportunities of delivering babies and
otherwise. During surgical residency the oral surgeons had a bit of a jump on
the traditional medical school graduate as we were already familiar with the
hospital and had already done much of our clinical rotations on oral surgery.
For that reason we were an asset for most of the surgical specialties. Oral and
maxillofacial surgery residency was great in New Orleans. Working at Charity
Hospital we were fortunate to have exposure to a lot of "business" as New
Orleans never shuts a party down so there was always trauma from fights,
accidents and otherwise but also Charity was wonderful in regards to the
opportunity to truly do, see and accomplish what we wanted as the care was
covered by the state institution. Unfortunately this has changed. It was a very
resident run program where essentially it was see one, teach one and do one. In
addition residency and medical school was fantastic as time in New Orleans was
awesome. Work hard but also the opportunity to run around and see the city.
New Orleans always had something going on whether it was Jazz Fest, Mardi
Gras, French Quarter Festival or otherwise. Again a wonderful place to train. If
you could not find something to do in New Orleans during your free time you
were not looking.
2. What type of continuing education did you and do have to complete?
As both a dentist and physician I have to have continuing education that covers
both disciplines. Ultimately a lot of the continuing education comes through
meetings. Our national meeting gives a large portion of the continuing
education but also there are courses throughout the year that allow the
opportunity to truly gain the hours necessary to ensure that one is up to date on
the current standards, emerging technologies and otherwise. In addition
training residents also provides the opportunity to have continuing education
hours as we had several didactic programs throughout the year to ensure that
they are also up to speed on current clinical practices and the emerging
technologies.

3. How competitive is the field of your employment?

Ultimately oral and maxillofacial surgeons are essentially both in the dental and
medical world. We have primary referrals from our dental colleagues but also
we have referrals from the medical specialists who have concerns such as sleep
apnea or pathology. Certainly many of the referrals also come from
pediatricians. In terms of competitiveness there are approximately 20 or so oral
and maxillofacial surgeons within the Charlotte region. Carolinas Center for Oral
and Facial Surgery has the reputation of being the team that classically takes care of
most of the complexities such as jaw surgery, temporomandibular joint surgery
and covering most of the call for the region. Oral and maxillofacial surgeons
oftentimes are divided into those that prefer a private practice feel meaning more
of a 9-5 job where they truly remove wisdom teeth, take out teeth and do
implants to replace missing teeth. We certainly perform this as well but many
surgeons prefer to avoid bigger more complexities such as again orthognathic
surgery, temporomandibular joint surgery and other types of major
reconstruction. There is always competition. In fact it is rarely spoken about in
residency in terms of the need to market to your referrals, spend time with your
referrals so they appreciate who you are and how you are going to treat their
patients well and give them the best of care. So again with that being said it
certainly is competitive although everything is competitive. We certainly have a
niche and very much enjoy the services that we provide for our patients and
community.

4. What are your typical work hours?

Ultimately I have a bit of a subset within the field of oral and maxillofacial
surgery. I perform the lion's share of orthognathic surgery jaw surgery for the
practice. For this reason I oftentimes work at an even greater pace during the
summer and holiday season specifically when students have an opportunity to
 recover from the surgical intervention. Days can vary in terms of their length.
Some days I leave the house at 6 in the morning to round on patients and
prepare for the start of hospital cases around 7. During the busy peak season I
am may not get home until 6, 7 or 8 o'clock at night. In addition call
responsibilities may take me away during the evening hours. There are some
days however, where I get an opportunity to awake at a typical hour, help get
my kids prepared for school and drop my kids off at school. Work a day that is
fairly typical and maybe home some days by 5 or 6 in time for dinner. Certainly
my day has many ebbs and flows based on the season where individuals have a
chance to recover from the surgery that I perform. As mentioned previously
some surgeons prefer the 9-5 type job which is pretty routine, frankly
monotonous in my opinion versus mine which again does vary depending on
the time of the year and depends on the day. Certainly it is advantageous as
there is something new daily.

5. How much of the day are you in appointments versus performing surgery?
Classically oral and maxillofacial surgeons perform surgery during the day as
we typically use sedation for dentoalveolar and implant surgeries are generally
performed in the morning as people have to fast. The day is typically broken
into surgeries in the morning and consultations in the afternoon talking about
an individual's potential need for surgery. Once again I have a subset within our
discipline meaning there are some days that surgery goes from 7 in the morning
until 6 at night. There are also some days where it may be simply all
consultations. Again I typically have quite a bit of variance in the day but in
general most surgeon's days are broken into 50% surgeries classically in the
morning and 50% consultations in the afternoon but again everyone's schedule
can vary depending on the day and season. For example within our practice I
typically perform major surgeries on Tuesdays and Thursdays. Tuesdays within
the hospital and Thursdays within the office. In terms of major surgeries I mean
utilizing an anesthesia service. I have partners who have a similar schedule
where they may be designated as having major surgery time or block time on
Monday or Wednesday or Friday or otherwise. Days that are not set aside for
major surgery of course have the typical dentoalveolar type pattern where it is
again surgery in the morning, consultations in the afternoon.

6. What is the most common task you complete in your work?

I would say the most common task of course is handling referrals that are sent
to the office to discuss varying degrees of needs. Once again it could stem from
a young individual requiring removal of baby teeth that are ankylosed or
impeding eruption of the permanent teeth, implant placement for those that are
missing teeth, removal of the 3rd molars as 90% of the world does not have
quite enough room for their eruption into the mouth all the way to those
individuals who have functional challenges associated with skeletal
 discrepancies. The tasks in my opinion are typically about 60% taking care of
patients and 40% administrative. In terms of administrative I mean dictating
the notes, completing electronic medical records for office visits, addressing
insurance appeals and insurance submissions. In addition I am the chairman of
oral surgery at both CMC and Novant hospitals. For this reason I sign off on
privileges for other specialties. This can be time consuming at various points
throughout the year. In addition administrative measures also require
marketing, returning phone calls to referrals as well as lecturing to both local,
national and international conferences. For this reason the day can be quite
busy in terms of patient care but also handling other administrative necessities.
The most challenging aspect of the job truly is of course patient care. You will
find this as you continue your path to become a surgeon. Certainly we always
want things to go well but unfortunately things can deviate from our initial plan.
As a surgeon there is typically always someone on your mind something that is
not quite progressing the way you anticipate. You will learn that the best means
is to run for an individual to look them in the eyes, help them get through it and
ultimately every one typically does get through it. After you get that individual
through it unfortunately someone else usually comes by or through the office
that unfortunately takes their place. We as surgeons end up spending a lot of
time staring at the ceiling thinking about things. So certainly the challenge can
be that hiccup or hurdle that is in daily patient care. The other most challenging
aspect of life and work is truly developing time to family. One can get too
focused on the professional side and forget the personal side. I oftentimes am
guilty of this. Finding the balance between profession and personal is very, very
important and is truly probably my biggest challenge.

7. How has your career as a surgeon changed based on technology?

The decreased principle of technologies in oral and maxillofacial surgery has
been imaging. When I initially started oral and maxillofacial surgery everything
was done on plain films essentially the two-dimensional world. With the advent
of office based CT scans or cone beams this provides the opportunity for a
three-dimensional view. The three-dimensional view truly helped advance
surgery. The imaging also allowed the opportunity for the development of
Virtual Surgical Planning. We are quite proud in Charlotte as we have been
pioneers on the development of Virtual Surgical Planning. Essentially we have
developed a model that allows the opportunity to merge skeletal information
collected from our office base cone beam CT scans as well as dental information.
All of this information can be subsequently merged into programs which allows
us to visualize the skeletal relationship, bite relationship and tooth relationship
of an individual. This allows the opportunity for us to plan whether it is implant
placement, whether it is jaw surgery, whether it is reconstruction for an
individual who needs the return of tissue or bone after ablation of cancer has
caused a defect. Ultimately the Virtual Surgical Planning technology has
 improved accuracy of our procedures, it has improved the efficiency of the
procedures and it has truly allowed surgeons to deliver better results. I use
Virtual Surgical Planning technology daily and it is truly the future for
specialties not only in oral and maxillofacial surgery but also orthopedics. For
example in orthopedics as opposed to stock joints or replacement of hips and
knees meaning small, medium, large, left and right. Ultimately it is likely is
moving to where it will become customized to where you will be able to take an
individual's knee for example it will be scanned and within several days you will
be able to essentially place a custom total joint that will aid in returning
function and form to that individual but will essentially again be custom and not
a stock type prosthetic. Interesting technology and amazing how the field
continues to grow.

8. Research shows that only 7% of females work in orthopedic surgery. Is this true
in your profession?
It unfortunately is. Once again an oral and maxillofacial surgeon has typically
spent at least 4 if not 6 years following the completion of a 4 year dental
program. Certainly there are many wonderful female surgeons out there. I am
friends with many of them and see them on the lecture circuit or at conferences.
It is however, similar to the orthopedic world where there is certainly a large
minority of females within the specialty. Oral and maxillofacial surgery
continues to attempt to improve the exposure and access to all both female and
minority individuals through the development of scholarships. Dentistry
provides a wonderful opportunity to truly run one's own private practice.
Whether you are male or female you have the opportunity to run essentially
your own small business and you can work when you want. You may choose to
work 5 days a week. You may choose to work 3 days a week. But again it allows
the opportunity for females to potentially be both a mom and a surgeon or
dentist. For this reason this is likely the etiology for the small numbers. I would
be interested however, to evaluate the numbers as we move forward 5 years,
10 years and 20 years because I do feel that more and more women are
choosing to go down the path of oral surgery and I would trust that many
females will also be doing the same on the orthopedic surgery side.

Taylor I hope this is what you were after. I apologize if it is a bit long winded.
Should you have any questions or thoughts I know this is due soon but please do not
hesitate to reach out and I will be more than happy to call and touch base with you
to answer any questions that you may have. Good luck not only with this project but
with the completion of school and all your future endeavors. Once again if I can help
please do not hesitate to contact me in any way.
Brian B. Farrell, D.D.S., M.D. (Electronically Signed)
BBF/dk